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NUTRITION SUPPORT FOR BURN INJURY Adapted from Medical Nutrition Therapy – A Case Study Approach Marcia Nelms Mr. Angelo is a 65-year-old male who has been admitted to the surgical intensive care unit (SICU) for treatment of serious burns estimated to cover 40% of his body as well as suspected smoke inhalation injury. Patient Summary: Mr. Angelo is a 65-year-old male admitted as a level 2 trauma with 40% total body surface area burns after being involved in a trailer fire. He is admitted to the surgical intensive care unit (SICU) for management of burn injury. History: Onset of disease: Patient is unclear about what occurred, and his story changed several times during assessment. Patient lost his job recently and was coming from Atlanta to move in with his parents. He was driving behind an RV in a caravan when the RV caught fire. Apparently, he was in the front cab of the RV trying to put out an engine fire when his clothes caught on fire. He jumped out of the car and rolled on the ground to put out the flames. At one time, he stated that he jumped into a ravine, but later he stated this was not the case. He received 1650 cc of normal saline en route to the hospital. The burn involves the face, bilateral upper extremity, bilateral lower extremity, scrotum, back and buttocks. The ENT service evaluated the patient and performed a nasopharyngolaryngoscopy. Findings included laryngeal edema and soot on the vocal cords bilaterally. Recommendation is to intubate for airway protection due to edema and soot on the vocal cords. Patient does have occasional wheezing and some patchy infiltrates on chest x-ray that could be related to smoke inhalation. Patient was started on fluid resuscitation per Parkland formula using lactated Ringer’s (LR) @610mL/hr. Medical history: diabetes, HTN, GERD. Tobacco use: smokes 1ppd for > 30 years. Alcohol use: 2-3 beers daily and a case on Saturday and Sunday Admitting History/Physical: General appearance: Alert, cooperative, mild distress, appears stated age. The wounds appear to have ruptured blisters and devitalized skin. Vital Signs: Temp: 100 Pulse: 120 Resp rate: 22 BP: 140/93 Ht: 72” Wt: 71.2 kg HEENT: Head/face: burns involving entire face, singed eyebrows, hair & facial hairlungs: Clear to auscultation bilaterally Heart: tachycardia, regular rhythum Abdomen: soft, skin tender. Bowel sounds normal.
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Upper extremities: Burns noted R bicep, forearm, hand, left bicep and hand, mostly second degree. Skin sloughing and devitalized tissue Lower extremities: mostly full thickness burns noted to bilateral lower extremities Back:
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  • Summer '16
  • Dr. Willy
  • Nutrition, Mr. Angelo, Weekly indirect calorimetry

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